DEATH CERTIFICATE

12. Of Hispanic Origin?

13. Ever in U.S. Armed Forces?

16a. Place of Death

16c. Place of Death in City Limits?

18f. Residence Inside City Limits?

22a. Method of Disposition

4 + 1 =

Burton Funeral Home - "Committed to Excellence"

717 Hwy. 49 W. Jefferson, Texas 75657  Phone: 903-665-8712  Fax: 903-665-6752
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